Workers' compensation and the utilization review

On behalf of O'Mara & Padilla, Attorneys at Law posted in workers' compensation on Monday, August 14, 2017.

Being injured on the job can take its toll on an individual. An injured worker may, of course, be subjected to physical pain, but he or she may also have extensive financial losses in the form of lost wages and medical expenses. When a workplace injury leaves an individual unable to work and, therefore, unable to earn a wage, it can be difficult to make ends meet. Although workers' compensation benefits may be available to help such an individual recoup his or her losses and provide time for him or her to recover from the injury, maintaining those benefits and securing the medical care one needs isn't always easy.

One reason is because recipients of workers' compensation benefits are subjected to utilization review. Utilization review is the process by which workers' compensation claims administrators determine whether to approve a course of treatment that is recommended by an injured worker's doctor. This program is mandatory, so every individual who received workers' compensation benefits will have to go through it.

Sometimes after a utilization review, an injured worker's doctor's recommendations for medical care are denied, meaning that worker's compensation will not pay for it. When this happens, the worker can file a complaint, at which time the utilization review will be analyzed by an independent medical review. This review panel will then determine whether or not the recommended course of treatment is medically necessary to allow the worker to recover from his or her injury.

This is just one of the many areas of the workers' compensation system that can be frustrating. However, injured workers have a multitude of legal rights meant to protect them from unfair treatment. However, unless these individuals act on their rights, they may lose out on the benefits to which they are entitled. For this reason, many injured workers find it in their best interest to discuss their case with an experienced attorney.

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